Running with Gazelles, Eating with Lions

“Every morning in Africa, a gazelle wakes up. It knows it must run faster than the fastest lion or it will be killed. Every morning a lion wakes up. It knows it must outrun the slowest gazelle or it will starve to death. It doesn’t matter whether you are a lion or a gazelle. When the sun comes up, you better start running.”

The concept of a flattened world was embraced by people after the publication of Thomas Friedman’s international bestselling book “The World is Flat” (4.5 million copies of which were sold in 42 different languages). The kind of product or service or where the work is performed does not matter; what matters is the accuracy as services are always measured by their accuracy.

Faced with problems such as lower reimbursement, cash flow impacts, margins shrinkage, increasing medical insurance premium costs, lack of quality reporting measures, new ICD 10 codes, an increasing demand for credentialed and experienced resources, an increasing number of hospitals, and less time for patient care, many hospitals and physician groups have outsourced their Revenue Cycle Management (RCM), which includes Coding, to Professional Business Process Management companies. As though these were not enough, the 11th Revision of the International Classification of Diseases is due by 2018!

A recent Black Book survey, comprising responses of 1309 hospital chief financial officers (CFOs) and business office leaders, has revealed that outsourcing of complex claims to a specialized provider climbed from 20.4% of all US hospitals in 2013 to 39.8% in Q3 2016. Another revelation is that 49% of hospital CFOs acknowledged that outsourcing (including offshoring) had become a more viable alternative in 2017 for more parts of their organizational claim processing. Black Book report projects that the market for outsourced RCM will grow at a compound annual growth rate of 26.5% through 2018.The market is expected to reach a value of $9.7 billion by 2018.

More than half of the healthcare organizations (54%) believe that outsourcing RCM functions would improve efficiency and their financial health.

Outsourcing already has a significant foothold in the RCM market; 83% of hospitals outsource some accounts receivable and collections. Other outsourced services include:

• Contract management: 58%
• Denial management: 55%

The challenge for an organization’s business office leaders is to identify their unique need and evaluate and determine their right partner with the expertise, resources, infrastructure, unique technology-driven approach, and compliance to find a simple and inexpensive solution to their complex coding and RCM challenges.

An outsourcing relationship should be a smart sourcing partnership and more than just saving money. As regards coding, you are not purchasing or staffing coders. You are contracting for better outcomes and providing a comprehensive outsourced solution throughout the engagement.

The best practice for an offshore partner is to house all staff within a single/multi-centralized facility (with a robust disaster recovery management and business continuity plan) with direct oversight and high-security management. The benefits of offshore coding are around-the-clock and over-the-weekend coverage, end-to-end visibility of the business, flexibility to market demands, customized and scalable solutions, and regulatory changes. Organizations can take their coding production to 24/7 operation, avoiding fluctuations in discharged, not final billed.

The newest trend

A flexible, blended hybrid model is the new trend which allows an organization to determine delivery locations that best fit its specific requirement, domestic or international coding geography, budget, 24/7 coverage, workload balance, and dedicated and mirrored account management.

This offshore outsourcing model has helped organizations and hospitals that dedicate operational resources and physical space to improving patient care and satisfaction, generating/optimizing revenue, and increasing productivity. Organizations employing an offshore solution have the capability to go “above and beyond,” and it is always a dual bonus to have time and money saved.